HISTOPATHOLOGY OF RENAL POSTTRANSPLANT LYMPHOPROLIFERATION - COMPARISON WITH REJECTION USING THE BANFF SCHEMA

The Banff schema for renal transplant pathology was applied to (1) nin e specimens with renal posttransplant lymphoproliferative disease (PTL D) documented by Epstein-Barr virus in situ hybridization and analysis for B-cell lineage and (2) nine allograft nephrectomies classified as severe acute rejection (SAR) based on severe tubulitis, T-cell inters titial infiltration, and absence of Epstein-Barr virus, Tubulitis, ven ulitis, and infiltration of hilar soft tissues was demonstrable in all specimens, Hemorrhagic infarct-type necrosis was universal in SAR, bu t occurred in only three of the nine PTLD lesions (P < 0.05, Fisher's exact test), Arteritis in extrarenal vessels was more frequent (nine o f nine SAR v four of nine PTLD) and severe (eight of nine Banff grade v3 SAR v four of nine Banff grade v1 PTLD) in SAR, Intrarenal arteries entrapped within PTLD showed grade v3 vasculitis in two cases, Expans ile interstitial mononuclear infiltrates, nuclear atypia, and serpigin ous necrosis were seen only in PTLD (nine of nine cases), It is conclu ded that the quality of the cellular infiltrate, its expansile nature, and the presence of serpiginous necrosis help distinguish between sev ere SAR and PTLD, Tubulitis and intimal arteritis, lesions regarded as specific for rejection in the Banff schema, do not have absolute disc riminatory value in this clinical setting. (C) 1996 by the National Ki dney Foundation, Inc.